Judgment, Reasoning, and the Simulated Student: Transformational Approaches to … ·...
32
Judgment, Reasoning, and the Simulated Student: Transformational Approaches to High Leverage Teaching Rachel Onello, PhD, RN, CHSE, CNE, CNL Clinical Associate Professor Director, Clinical Simulation Lab University of South Carolina, College of Nursing
Transcript of Judgment, Reasoning, and the Simulated Student: Transformational Approaches to … ·...
Judgment, Reasoning, and the Simulated Student:
Transformational Approaches to High Leverage Teaching
Rachel Onello, PhD, RN, CHSE, CNE, CNLClinical Associate Professor
Director, Clinical Simulation LabUniversity of South Carolina, College of Nursing
Objectives
Examine how the process through which individuals interpret and make meaning can impact learning outcomes
Discuss the importance of cognitive frames in the identification of high leverage teaching
Discover the relationship between judgment, reasoning, and high leverage teaching
Explore simulation-based faculty development strategies for preparing faculty to recognize and engage in high leverage teaching
A Space For Learning…
The Basic Assumption
We believe our learners are intelligent, capable, care about doing their
best, and want to improve.
Group Introductions…
The Ladder of Inference
Adapted from: Argyris, C. (1990). Overcoming organizational defenses:
Facilitating organizational learning. Upper Saddle River, NJ: Pearson.
How did George do?
What objective, concrete, behaviors
would you use as the basis of your
discussion?
LOI, Meaning Making, Judgments
Impact of Perspective
Importance of Cognitive Frames
Adapted from: Rudolph, J.W., Simon, R., Dufresne, R.L., & Raemer, D.B. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55.
Assumptions
Feelings
Goals
Rules
Knowledge Base
Situational Awareness
_
_
_ __
__
Frames, Actions, and Results
Desired
Performance
Desired
Performance
MEET LUKE…
Why This Matters in Nursing Education…
High Leverage Teaching
Capitalizing on high leverage points in teacher/learner interactions
High leverage points
Recognizing own frames and rung on ladder
Seeking to understand the cognitive frames driving the learner’s decisions and actions
Meeting the learner where they are with their unique perspective and partnering with them
Understanding why learners choose a specific course of action
Value that learners chose that course for reason that made sense to them at the time
Commit to understanding how learner made sense of situation
Learning as meaning-making rather than passage of information
Requires authentic curiosity about learner’s perspective and respect that they are rational, well-intended individuals trying to do the right thing
A Compounding Challenge…
Thank you!!!
____
Transforming Learning through High Leverage Teaching
Simulation as a Faculty Development Tool
Teaching the Teachers
Simulation cases designed to place faculty in various teaching environments and contexts
Teach faculty to recognize and engage in high leverage points
Skills in:
Facilitating purposeful and meaningful learning conversations (critical conversations)
Applying debriefing across the curriculum
Raising consciousness of the Ladder of Inference and ‘climbing their rungs’
Fostering appreciation for understanding learners’ sense making process
Real time feedback and coaching that helps uncover blind spots and reinforces reflective practice
Standardized Students
Simulated participants (SPs) trained to portray the role of a student
Cases designed to replicate realistic, challenging teaching contexts
Environment: classroom, clinical, simulation lab
Learner Challenges
Unconsciously incompetent
Failure to progress
Overly confident
Disengaged
Generational
Situations
Blame game
Off the farm
Group learning with time-in, time-out coaching
Improving Outcomes Through Simulation-Based Faculty Development
Clinical Instructor Workshop (University of Maryland Institute for Educators)
Face-to-face didactic followed by hands-on immersion
Scaffolding from micro-skills to comprehensive facilitation of learning conversation
Simulated students portraying challenging clinical teaching situations
RCT Feasibility Study
Use of simulated students to develop instructor skill sets
4-hour simulation-enhanced workshop with simulated students
Effects of using simulated students for instructor development
Feasibility of using simulated students as an evaluation method for assessing instructor skills
Improving Outcomes Through Simulation-Based Faculty Development
Based on pilot study data, simulation-enhanced training resulted in improved*:Maintenance of learning environment
Structure of learning conversation
Transparency of thought, reasoning, and reflection
Exploration of cognitive frames and sense-making processes
Incorporation of coaching and teaching strategies
Based on qualitative data from instructors and standardized students:Decreased punitive, one-way conversation
Increased reflective dialogue with learner
“Opened my mind, slowed me down, and listened more”
“Helped me to see how I operate in conversations and how I can improve”
Faculty Development Curriculum for High Leverage Teaching
High
Regard
High
Standards
Respect, Curiosity, Helpfulness
From: Rudolph, J.W., Simon, R., Dufresne, R.L., & Raemer, D.B. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55.
A component of holding others in high regard: The Basic Stance
Component of High Standards: Advocacy-Inquiry*
Preview: I would like to discuss… Is now a good time for you?
Observations: I saw/heard [specifically]…
Point of View: I think [I am concerned, I was pleased]...
Inquire: I wonder [about your thoughts at the time]…
Listen to the learner
Coaching tailored to the learner’s frame
*Based on Debriefing with Good Judgment, developed by Rudolph, Simon, and colleagues (2006)
Phase I: REACTIONS & CONTEXTFocus on feelings
So you just took care of __________. How are
you feeling?
Focus on describing patient story
Tell me about the patient you cared for. Who is
this patient? What are your main concerns?
PHASE II: ANALYSISFocus on understanding/reflecting
PAAIL: Preview, advocacy, inquiry, listen…
Reflective techniques…
Deeper dives, unpacking…
Discussion, teaching…
PHASE III: SUMMARYFocus on application of learning
So based on… how would the care/priorities differ
if… (compare and contrast situations on patient
age change, acuity change, setting change, etc.)
Summarize or state at least one take-away from
today’s simulation that you will incorporate into
your practice.
A
D
V
O
C
A
C
Y
I
N
Q
U
I
R
Y
I SAW:
Sarah, I noticed that…
Mark, at one point in the simulation I
saw/heard that…
I THINK:
…I was thinking that…
…my concern is…
I WONDER:
…how were you seeing it?
…what was your take on that?
…if you can talk to me a bit about that?
…what was going on for you then?
…what was on your mind at that time?
…what were your thoughts about this?
REFERENCE:
Rudolph, JW; Simon, R;Dufresne, RL; & Raemer, DB. (2006) There’s No Such Thing
as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good
Judgment. Simulation in Healthcare, 1(1)
L
I
S
T
E
N
LISTEN TO UNDERSTAND:
What was driving learner’s decision?
Explore frame for further discussion
PREVIEW: I would like to discuss…
Is now a good time for you?SET
Adapted from Rudolph and colleagues (2006) and NLN Guide for Teaching Thinking (2016) Adapted by R. Onello– University of South Carolina College of Nursing
Debriefing with Good Judgment Cognitive Aid
Reflections…
References
Argyris, C. (1990). Overcoming organizational defenses: Facilitating organizational learning. Upper Saddle River, NJ: Pearson.
Forneris, S.G., & Fey, M. (Eds.). (2017). Critical Conversations: The NLN Guide for Teaching Thinking. Washington, DC: National League for Nursing.
Hayden, J.K., Smiley R.A., Alexander, M.A., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2 Suppl), S1-S64.
International Nursing Association for Clinical Simulation and Learning [INACSL]. (2015). Standards of Best Practice: Simulation. Available at: http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407
National League for Nursing Board of Governors. (2015). Debriefing Across the Curriculum. New York, NY: National League for Nursing.
National League for Nursing Board of Governors. (2015). A Vision for Teaching with Simulation. New York, NY: National League for Nursing.
Rudolph, J.W, Simon, R, Dufresne, R.L, Raemer, D.B. There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simul Healthc 2006;1:49-55.
Schon, D.A. (1987). Educating the Reflective Practitioner: Toward a new design for teaching and learning in the health professions. San Francisco, CA: Jossey-Bass.
Contact Information
Rachel Onello, PhD, RN, CHSE, CNE, CNL
Clinical Associate Professor
University of South Carolina, College of Nursing
